Colposcopy Lianne Beck, MD Assistant Professor Emory Family & Preventive MedicineSlide 2
INTRODUCTION The colposcopic exam serves to Identify typical points of interest Identify unusual territories in connection to these milestones Facilitate coordinated biopsy of anomalous zones for histologic conclusion Rule out intrusive growthSlide 3
INTRODUCTION Pre-dangerous and harmful cervical conditions create colposcopically identifiable epithelial changes that for the most part happen inside the change zoneSlide 4
SQUAMOUS METAPLASIA Physiological supplanting of the columnar epithelium with squamous epithelium The district where this happens is known as the TRANSFORMATION ZONE IMPORTANT in light of the fact that ALL cervical disease happen in this zoneSlide 5
Transformation ZoneSlide 6
Normal Colposcopic FindingsSlide 7
INTRODUCTION The key elements of the exam are the perception of the cervical epithelium after utilization of ordinary saline 3-5% acidic corrosive Lugol\'s iodine arrangement in progressive stridesSlide 8
INDICATIONS Suspicious unmistakable injury or tangible sore of the cervix, vagina, vulva, perineum or perianal zone Pap spread predictable with dysplasia or malignancy Pap spread with proof of HPV contamination (High Risk sorts) History of intrauterine DES presentation Follow-up of beforehand treated patients or high-chance patients Evaluation of tyke mishandle or assault casesSlide 10
RELATIVE CONTRAINDICATIONS Active, provocative cervicitis Non-helpful patient Postmenopausal patient who is not estrogen-prepared Heavy mensesSlide 11
Arranging ColposcopySlide 12
Steps in the colposcopic exam Explain the method and get educated assent Obtain a pertinent therapeutic history R/O pregnancy Perform bimanual exam if not effectively done Examine vulva Insert speculumSlide 13
Steps in the colposcopic exam Examine cervix utilizing low power (irritation, disease, leukoplakia, punctation, mosaicism, irregular vessels) Obtain KOH/WP, societies or potentially pap, if necessary Use green channel and typical salineSlide 14
Steps in the colposcopic exam Apply 5% acidic corrosive. Rehash Q 5 min. Check whole cervix with white light. Begin with low power and move to higher amplification to archive unusual vascular examplesSlide 15
5% Acetic Acid ApplicationSlide 16
Steps in the colposcopic exam Use endocervical speculum if necessary to view whole change zone The whole TZ, including SCJ , and outskirts of all injuries must be imagined with the end goal for colposcopy to be acceptableSlide 17
Steps in the colposcopic exam Apply Lugol\'s iodine answer for help in depicting potential biopsy siteSlide 18
Perform endocervical curettage, if showed Glandular injury Unsatisfactory colposcopy Normal colpoposcopy of ectocervix, yet anomalous cytology CONTRAINDICATED in pregnancy or dynamic cervicitis Steps in the colposcopic examSlide 19
Steps in the colposcopic exam Mentally outline regions Mild acetowhite < Intensely acetowhite No vein design < Punctation < Mosaicism Diffuse unclear fringes < Sharply divided outskirts Follows ordinary forms of the cervix < "bumped up" Leukoplakia – as a rule a decent (condylomata) or awful sign Atypical vessels – more often than not growth Normal iodine response (dull) < Iodine-negative epithelium (yellow)Slide 20
Steps in the colposcopic exam Perform cervical biopsies, if fundamental Biopsy back ranges initial A profundity of 3 mm is satisfactory Biopsy zone of the sore with most exceedingly terrible components and nearest to SCJ, incorporate the zone with atypical vesselsSlide 21
Steps in the colposcopic exam Apply weight and Monsel\'s glue to draining destinations after biopsy Remove speculum and assess vaginal dividers, vulva, perineum, and perianal zones Allow patient to recuperate Document discoveries Discuss discoveries with patient and give post-technique directionsSlide 22
Post-Procedure Instructions No douching, intercourse, or tampons until spotting dies down Return for foul smell or release, pelvic agony, plentiful draining or fever Tylenol, ibuprofen, or Aleve might be utilized for cramping Otherwise, follow-up is generally 1-3 weeks to talk about histology comes about and conclusive treatmentSlide 25
Post-Procedure Instructions Encourage contraception once authoritative treatment finished Re-accentuate the relationship of cervical dysplasia with STDs, smoking, and non-monogamous sexual practices Stress patients long lasting dangers of HPV contaminationSlide 26
Complications Bleeding Reapply Monsel\'s answer Saturate the finish of a tampon with Monsel\'s and embed to give weight and astringent activity to persevering overflowing Cauterize the biopsy site Inject 1-2 cc of 2% lidocaine with epinephrine into the draining site Rarely, a cervical line of 4-0 absorbable suture over a profound biopsy siteSlide 27
Complications Infection is uncommon however regularly happens on the 3 rd or 4 th day after biopsy Avoid biopsy with dynamic cervicitis Pain can be limited via minding and cautious clarification of system, a warm room, NSAIDs given the prior night and morning of strategy (Avoid Aspirin) Missing sickness – absence of connection between\'s pap cytology and ensuing histologySlide 28
Colposcopic FindingsSlide 29
Normal Colposcopic Findings Original squamous epithelium Columnar epithelium Squamocolumnar intersection Squamous metaplasia Transformation ZoneSlide 30
Squamocolumnar JunctionSlide 31
Normal Findings w/5% Acetic AcidSlide 32
Normal discoveries with Lugol\'s answerSlide 33
Nabothian CystsSlide 38
Postmenopausal CervixSlide 39
Abnormal Colposcopic Findings Atypical change zone with the accompanying elements suggestive of dysplasia or neoplasia: 1. Punctation 2. Mosaicism 3. Leukoplakia 4. Acetowhite 5. Unusual veinsSlide 40
Punctation and MosaicismSlide 41
Acetowhite Changes CIN 1Slide 43
Acetowhite Changes CIN 1Slide 44
Acetowhite Changes CIN 2Slide 45
Acetowhite Changes CIN 3Slide 46
Abnormal Lugol\'s Iodine UptakeSlide 47
Comparison CIN1 versus CIN3Slide 48
Atypical VesselsSlide 49
Invasive CarcinomaSlide 50
Invasive carcinomaSlide 51
Glandular Lesions (AIS and Adenocarcinoma)Slide 52
Grading FindingsSlide 54
References American Society for Colposcopy and Cervical Pathology. www.asccp.org. Newkirk, G. The Colposcopic Examination. Pfenninger & Fowler\'s Procedures for Primary Care Physician: 616-630. Johnson, B. The Colposcopic Examination. American Family Physician. June 1996. AAFP Colposcopy Position Paper Colposcopy and Treatment of Cervical Intraepithelial Neoplasia: A Beginner\'s Manual. http://screening.iarc.fr/colpo.php
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